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111General introduction and outline of this thesisWithin the Oral and Maxillofacial Surgery residency program, much emphasis is placed on the development of proficient surgical performance. A resident’s skills are expected to meet the level and standard of an average surgeon, and procedural success is primarily measured based on technical outcomes. Many published studies investigate the biomedical outcomes of performed surgeries; however, increasing numbers of studies now report patients’ quality of life (QoL) as a result measurement.1 QoL is defined as a patient’s perception of the impact of their disease or treatment, or both, on their daily life and their physical, psychological, and emotional well-being.2 The measurement of postoperative QoL determines the impact of surgical procedures on the patient’s change in everyday functioning activity, and degree of postoperative pain and discomfort.3Dentoalveolar surgical procedures can result in inflammatory complications—such as pain, swelling, trismus, and infection—and many patients report negative impacts on lifestyle and oral function.3 Therefore, in contemporary oral and maxillofacial surgery, main goals include the reduction of preoperative anxiety, pain-free surgical procedures, proper postoperative care, reduction of postoperative pain, and monitoring of any changes in quality of life.As the majority of dentoalveolar procedures are performed with local anesthesia, dental injections are necessary to perform these surgical procedures. Mandibular block anesthesia is frequently used to achieve a painfree procedure. In the Netherlands, many patients experience injection-related anxiety (16.1%), and a small proportion suffer from dental phobia (1%).4, 5These patients most likely fear the pain of the injection and the bodily injury.6Mandibular block injections are considered mildly painful, and the pain lasts only a few seconds for the majority of people. However, around 8% of patients experience the mandibular block injection as being very painful, rating it with a score of 7 or higher on the 11-point visual analog scale (VAS).7 As such, many researchers have tested different techniques to reduce the pain and anxiety provoked by dental local anesthesia. Reported options include the preinjection use of local topical creams or sprays 8, or ice to dull the pain.9